Colorectal

Question 1

Symptoms of right sided tumours?

Answer 1

Anaemia
mild diarrhoea
abdo pain
palpable mass

Question 2

Symptoms of left sided tumours?

Answer 2

Altered bowel habit (as faecal content harder and lumen narrow)
blood and mucus PR
Abdo pain

Question 3

Symptoms of rectak tumours?

Answer 3

fresh bleeding
mucus
incomplete evacuation
tenesmus

Question 4

DOH guidelines for urgent referral?

Answer 4

At any age

• Rectal bleeding WITH a change in bowel habit to looser stools +/- increased frequency of defecation
• Definite palpable right sided abdominal mass
• Definite palpable rectal (not pelvic) mass
• Fe-deficiency anaemia without obvious cause

Over 60
-Rectal bleeding persistently without anal symptoms

-Change of bowel habit to looser stools +/- increased frequency of defaecation, without rectal bleeding and persistent for 6 weeks

Question 5

Risk in polyps associated with ca?

Answer 5

multiple
>10mm
villous adenoma
high grade dysplasia

Question 6

What is dysplasia?

Answer 6

Cytological and architectural atypia. Degree based on the severity of the cyto-architectural changes. Changes are restricted to the epithelium/mucosa. Pre-neoplastic lesions with alterations in oncogenes and tumour suppressor genes.

Question 7

What if FAP?

Answer 7

inherited mutation of APC gene (tumour suppressor)
loss of fx
100% cancer risk

Question 8

what is Lynchs syndrome?

Answer 8

Germline mutations in at least one of the genes encoding the mismatch repair system
80-90% risk
also associated with endometrial, urinary tract, duodenum
60% are in proximal colon

Question 9

Genetic risk factors?

Answer 9

HNPCC- 70-90%, diagnosed at 45
FAP- develop by 40 but most have had total colectomy by then

IBD
Kras mutations- lack response to anti EGFR treatment

Question 10

RIsk factors for CRC?

Answer 10

age
sedentary
no fibre
fat
alcohol
red meat 
smoking
HpV- anal
IBD

Question 11

Diagnosis of CRC?

Answer 11

Hx and Ex
DRE
Bloods: baseline and baseline CEA
colonoscopy
biopsy
imaging for mets

Question 12

What surgery in CRC?

Answer 12

tumour+adjacent tissue+ lymphatic drainage

Right hemicolectomy in right, left hemicolectomy in left

high anterior resection in sigmoid

transverse depends where it is

Question 13

What medical therapy is availiable in CRC?

Answer 13

5 FU
Capecitabine (5FU prodrug)
Oxaliplatin
irinotecan (first line in metastatic disease)

Radiation is only used in rectal cancers

Question 14

Targeted agents in CRC?

Answer 14

Anti VEGFR: bevacizumab

egfr inhib. cetuximab

Question 15

How should patients with CRC be followed up?

Answer 15

serial CEA measurements
colonoscopy 1 year on
surveillance colonoscopy every 3-5 years

Question 16

where does CRC met?

Answer 16

liver mainly, bone and small bowel is rare